Value-based care is when insurance companies pay health providers based on data measuring the overall health of a pool of patients, rather than for doctor visits and tests. Nemours Children’s Health System is one provider in Delaware moving aggressively towards this payment model.
Nemours launched its Value-Based Services Organization late last year and the number of its value-based purchasing contracts with insurers has since grown from two to eight. Under these contracts, Nemours is incentivized to score high on a national measuring system for health called the HEDIS measurements. Incentives could include shared savings or shared risk of medical costs.
Value-Based Services Executive Director Jamie Clarke says, for one thing, this means more phone calls to patients to be sure they’re up to date on their preventative care.
“We have a much more aggressive approach to doing proactive outreach to get children in for services if we identify they have a gap in care,” said Clarke.
Clarke adds Nemours also now follows up with pharmacists to make sure kids are picking up their prescribed asthma medication.
Nemours has added a data analytics team to report success in meeting the HEDIS measurements and has embedded care coordinators in all primary care clinics to align the efforts in each office towards value-based care.
“Our analytics team actually accumulates all of that data and works to give information to our care coordinators and our providers in a consolidated fashion, to allow them to actually provide … as much of their time providing care so they don’t have to sift through data,” said Clarke.
The Nemours Value-Based Services Organization got its start shortly before the state announced it would move all Medicaid contracts to value-based purchasing.
This move from the state requires Delaware’s two Medicaid Managed Care Organizations, AmeriHealth Caritas and Highmark Blue Cross Blue Shield Delaware, to rank in the top 50% in seven HEDIS categories or face a penalty.
Nemours has contracts with both insurers, but only some HEDIS categories apply, because Nemours exclusively treats children.